Oral Food Challenges

Oral food challenges need to be done as a day case procedure and access to full resuscitation equipment is essential, staff conducting and supervising oral food challenges should be competent in doing so.  The ability to recognize and treat allergic reactions is essential to patient safety.

Setting: Hospital/Paediatric Day Unit

  • 8g of Regular salted Peanuts, but peanut butter is a safer option for younger children.
  • If using peanut butter a generous spread over a (sliced pan) slice of bread, if the child cannot tolerate bread, crackers or bread the child can tolerate can be used.


  • Work the dose up every 15-20 minutes for example , ¼ peanut, ½, 1, 2 , etc.
  • Using peanut butter on bread, divide into 5 doses the last dose being half the amount, work the doses out backwards if it’s easier.
  • Children must be observed for 2 hrs after completion of the last dose.


  • The taste can be difficult to tolerate so peanuts can be crushed up and the doses can be mixed with yoghurt as an alternative, jam can be used over the peanut butter to help disguise the taste.

Outcome 1: If the oral food challenge is negative peanut must be introduced into the diet at least 2-3 times a week.

Outcome 2: If the oral food challenge is positive peanut must be strictly avoided, and arrange appropriate follow up as per care pathway.